FAQ

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In the compliance arena, Medclaims Billing Services’ management leads by example. Therefore, a culture of compliance exists in every activity undertaken by management, consultants and employees. The compliance program has been crafted in the spirit of the Compliance Program Guidance for Third Party Medical Billing Companies, published by the Office of the Inspector General. To this end, a strict code of conduct is adhered-to in discharging all business responsibilities with employees, clients, patients, insurance carriers and other business partners. While striving to collect what clients are legally and ethically entitled to, our efforts will always be within all applicable regulations and guidelines.
This question is best answered with another question: Why do you pay an accountant to do your taxes? Professional billers know the industry inside out and have the right tools to get the job done. In addition, office billing-costs (salary, Workman Compensation insurance, etc) can be eliminated or substantially reduced. You no longer have to worry about the billing getting done, when your biller calls in sick. In summary, cash flow will improve while certain costs will be reduced or eliminated.
Clients see immediate improvement in cash flow. This is because our total focus is billing. Unlike office billers, we are compensated based on what we collect. Therefore, we work very hard to maximize collections. We also have state-of-the-art tools and we are experts in medical billing. This means that the job gets done correct the first time. We have also fostered good relationships with our business partners. So, when problems arise, we take care of them fast and seamlessly.
The vast majority of claims, except to some very small carriers, go out electronically. This is the case for primary and secondary claims. Medicare and Blue Cross claims go directly, while other commercial claims go out via Change Healthcare and Office Ally. Therefore, most claims are adjudicated within 7 to 10 days. Medicare Explanation of Benefits (EOBs) are received electronically and are automatically posted in our system. Secondary carriers or patients billing are automatically triggered at this point.
Our office and resources are a natural extension to your practice.
  • Capturing patient demographics and insurance information.
  • Posting charges.
  • Editing claims.
  • Claims submission.
  • Carrier billing.
  • Insurance and patient follow up.
  • Patient billing.
  • Appeals.
  • Professional consultation.
  • Assistance with Medicare and other insurances certification.
  • And much more…
  • Superbills are either faxed or mailed to Medclaims Billing Services.
  • Charges are entered and claims are edited.
  • Claims are submitted.
  • Electronic submission reports are reviewed for errors, if any.
  • Explanation of Benefits (EOBs) and payments arrive at practices, and copies are sent to Medclaims Billing Services by practices.
  • Carriers’ payments are posted.
  • When applicable, secondary carriers are billed.
  • Patients are billed, and payments are posted.
  • Monthly, reports are generated and delivered to practices.
  • Monthly, all open charges are followed up with carriers.
This is up to you. Whatever works for your practice, works for us. We do, however, ask for consistency in the schedule.
YES. Not doing so is a possible contractual violation between the patient and insurance carrier, and even the provider and the insurance carrier! If co-pays are not collected at the time of service, patients will receive statements accordingly.
We collect 100% of what our clients are legally and ethically entitled to. Said another way, we will collect 100% of the allowed amounts stipulated in contracts with the insurance carriers. All unpaid claims over 60 days are followed up monthly and, when necessary, the appropriate appeals are filed. We will not stop until our clients are paid what they have rightfully earned.
Patients’ statements are sent out electronically via Change Healthcare. Change Healthcare edits the statements and sends them out on multicolor paper. Practices have the option to indicate credit card payments on the statements. When patients move, the statements are forwarded to the new address and a report is sent to Medclaims Billing Services.
There are variety of reports available. Data can be summarized or detailed in many different ways and formats. Clients typically choose the reports and frequency that best suits their needs. Most clients choose to receive their reports monthly, after the month has been closed.
Yes. This is accomplished via HIPAA HL7 protocol messages. As long as your EMR system supports the standard HL7 version, the systems can interface.
Yes. Sending out patient statements via e-mail is available. Patients receive an e-mail with a secured and HIPAA-compliant web-page link. Patients log on to this page to access their balances, make payments, and view other important information such as demographics and insurance coverage. Patients whom do not want to subscribe to this service will continue to receive statements by mail.
Our fee is based on what is collected, not what is billed, and will be agreed upon during contract negotiations. Contact us for details.
We use PDS MD Suite by Data Strategies, Inc. Founded in 1982, DSI has helped thousands of healthcare professionals accomplish mission-critical tasks. Yes, you can. Generally speaking, there may be additional fees associated with this service.
Many. Most significant, you need not have to purchase scheduling software, worry about data backups or purchase and maintain additional hardware.
Yes! All billing data is backed up multiple times during the day to a separate storage device. More over, it is sent off-site nightly, where it is stored in multiple locations throughout the US. In addition, our data server is protected by firewall, virus and malicious protection softwares. Strict user password policies are also maintained.
Once we have agreed on the terms, three documents must be prepared. The Billing Services Agreement outlines the terms as well as our mutual responsibilities. The Business Associate Agreement is A HIPAA document stipulating HIPAA requirements. In addition, a Practice Profile is filled out by the client outlining information such as tax ID, state license, Medicare provider number, etc. Please contact us to get on the road to financial stability!
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